一起重症监护病房疑似耐碳青霉烯类鲍曼不动杆菌医院感染暴发调查

Investigation on a suspected outbreak of carbapenem-resistant Acinetobacter baumannii nosocomial infection in an intensive care unit

【目的】对重症监护病房(ICU)发生的一起疑似耐碳青霉烯类鲍曼不动杆菌(CRAB)医院感染暴发事件进行分析,为多重耐药菌医院感染防控提供参考。【方法】收集2021年11月仁济医院综合ICU发生的4例CRAB感染患者的临床资料、流行病学史、环境卫生学监测和多位点序列分型(MLST)数据,进行回顾性分析。【结果】共发生4例CRAB肺部感染,其中1例病例为社区获得性感染,3例为医院获得性感染,分离的菌株耐药性相同,且均属于ST368型。40个物体表面和医务人员手样本中,在首发病例的输液架和床旁的回风口滤网检出CRAB共2株,检出率为5%。在采取集中隔离CRAB感染患者、改进环境清洁消毒流程、加强手卫生、加强人员管理和培训及督导等措施后,未再发生同类CRAB感染病例。【结论】此次疑似CRAB医院感染暴发可能与环境清洁消毒不彻底及手卫生执行不到位有关。及时识别和调查,采取有针对性的整改措施是控制医院感染暴发的关键。

[Objective]To investigate a suspected outbreak of carbapenem-resistant Acinetobacter baumannii(CRAB)nosocomial infection in an intensive care unit(ICU)and provide scientific evidence for prevention and control of multi-drug resistant nosocomial infection.[Methods]Clinical and epidemiological data of 4 patients with CRAB infection were retrospectively investigated in the ICU of Renji Hospital in November 2021.Environmental hygiene monitoring and multilocus sequence typing(MLST)were conducted and intervention measures were taken.[Results]A total of 4 cases with CRAB infection were identified,among which 1 case was determined to be community-acquired and 3 cases were hospital-acquired.The isolated strains shared the same drug resistance,and were all classified into ST368 type.In the surface and hand samples(n=40),2 CRAB strains were detected in the air filter beside the bed of the first case,with a detection rate of 5%.After adopting comprehensive prevention and control strategies,including environmental cleaning and disinfection,hand hygiene,staff management and training,and supervision,no similar case with CRAB infection was found.[Conclusion]This suspected outbreak of CRAB nosocomial infection may be induced by inadequate environmental cleaning and disinfection,and inadequate implementation of hand hygiene.Timely identification,investigation,and targeted measures remain crucial to effective control of possible nosocomial infection.